Improving dementia reviews

harro
image source: http://www.nhsconfed.org/

In Harrogate, people with dementia traditionally had three routine reviews a year: two at the Tees, Esk and Wear Valleys NHS Foundation Trust memory clinic, and one at their GP practice. This limited the number of appointments available at the memory clinic, and meant those who really needed specialist care had to wait longer for it.

Harrogate and Rural District Clinical Commissioning Group (CCG) and Tees, Esk and Wear Valleys NHS Foundation Trust worked with local GP practices to improve the system for routine reviews. Since 2014, such reviews have been shared between the trust and GPs. Those with dementia are now seen alternately by their GP and the memory clinic at six monthly intervals.

Read the full document here

Diagnostic test accuracy of informant-based tools to diagnose dementia in older hospital patients with delirium

Jackson, T.A. et al. Age Ageing. (2016) 45 (4): 505-511.

Background: delirium and dementia co-exist commonly in hospital. Older people with delirium have high rates of undiagnosed dementia, but delirium affects the use of cognitive testing in dementia diagnosis. Novel methods to detect dementia in delirium are needed. The purpose of the study was to investigate the diagnostic test accuracy of informant tools to detect dementia in hospitalised older people with delirium.

Methods: the presence of dementia on admission was assessed using the short form of the Informant Questionnaire of Cognitive Decline in the Elderly (IQCODE-SF) and Alzheimer’s Disease 8 (AD8) in people over 70 years old with delirium. Reference standard diagnosis was made using Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) criteria at 3 months. The main outcome measures were the diagnostic test accuracy of the IQCODE-SF and the AD8 in diagnosing DSM-IV dementia.

Results: dementia prevalence at 3 months was 61%. The area under the receiver operating characteristic curve (AUROC) was 0.93 (P < 0.0005) for admission IQCODE-SF and 0.91 (P < 0.0005) for admission AD8. An IQCODE-SF test result of >3.82 on admission had a sensitivity of 0.91 (0.79–0.97) and specificity of 0.93 (0.76–0.99) for detecting dementia. An AD8 of >6 had a sensitivity of 0.83 (0.69–0.92) and specificity of 0.90 (0.72–0.97) for detecting dementia.

Conclusion: the IQCODE-SF and AD8 are sensitive and specific tools to detect prior dementia in older people with delirium. The routine use of either tool in practice could have important clinical impact, by improving the recognition and hence management of those with dementia.

Read the article here

Study addresses safety concerns for older adults with diagnosed/undiagnosed dementia

ScienceDaily. Published online: 23 June 2016

B0005919 The criminal mind
Image source: Rowena Dugdale – Wellcome Images // CC BY-NC-ND 4.0

Dementia currently affects some 5 million people in the U.S., and that number is expected to triple by 2050. Having dementia affects the way you think, act, and make decisions.

In a study published in the Journal of the American Geriatrics Society, researchers examined how often older adults who have diagnosed and undiagnosed dementia engage in potentially unsafe activities.

The researchers examined 7,609 Medicare beneficiaries aged 65 to more than 90-years-old. Based on various cognitive tests, the researchers determined that 1,038 of the people they observed had probable dementia. Of that group, 457 had been diagnosed with dementia and 581 had not been diagnosed with dementia.

Nearly 1,000 participants tested as having “possible” dementia and 5,575 did not have dementia. Of the older adults with probable dementia, the researchers learned that:

  • 23 percent were still driving
  • 31 percent prepared hot meals
  • 22 percent managed their own finances
  • 37 percent managed their own medications
  • 21 percent attended doctors’ appointments alone

Read the full commentary here

Read the original research abstract here

Big data to smart data in AD: Real-world examples of advanced modeling and simulation

Haas, M. et al. Alzheimer’s & Dementia. Published online: 18 June 2016

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Image source: Marina Caruso – Wellcome Images // CC BY-NC-ND 4.0

Many disease-modifying clinical development programs in Alzheimer’s disease (AD) have failed to date, and development of new and advanced preclinical models that generate actionable knowledge is desperately needed. This review reports on computer-based modeling and simulation approach as a powerful tool in AD research.

Statistical data-analysis techniques can identify associations between certain data and phenotypes, such as diagnosis or disease progression. Other approaches integrate domain expertise in a formalized mathematical way to understand how specific components of pathology integrate into complex brain networks. Private-public partnerships focused on data sharing, causal inference and pathway-based analysis, crowdsourcing, and mechanism-based quantitative systems modeling represent successful real-world modeling examples with substantial impact on CNS diseases.

Similar to other disease indications, successful real-world examples of advanced simulation can generate actionable support of drug discovery and development in AD, illustrating the value that can be generated for different stakeholders.

Read the full article here

Commissioning for Value packs for CCGs

NHS Rightcare has published the last four in its set of Commissioning for Value packs for CCGs to help them identify the best opportunities for improving value for their populations.

ccgright
Image source: http://www.england.nhs.uk

The focus packs are on Cancer and Tumours; Mental Health and Dementia; Maternity and Early Years; and Musculoskeletal, Trauma and Injuries.  The information contained in each pack is designed to support local discussions and inform a more in-depth analysis around common conditions and pathways.

NHS Rotherham CCG focus packs available here

Carers Week 6 – 12 June

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Image source: Kai Hendry – Flickr // CC BY 2.0

Carers Week is an annual campaign to raise awareness of caring by highlighting the challenges that carers face and recognise the contribution they make to families and communities throughout the UK.

The campaign encourages others to organise activities and events throughout the UK.

This year the campaign will be focusing on building Carer Friendly Communities: Communities which support carers to look after their family or friends well, while recognising that they are individuals with needs of their own.

Is beer good for the brain?

ScienceDaily. Published online: 1 June 2016

beer-1290633_960_720While most people will agree that excessive consumption of alcohol can have a detrimental effect on the brain, there is less agreement regarding the effects of light or moderate drinking. This includes concern and controversy surrounding the effects of drinking on the development of neurodegenerative diseases such as Alzheimer’s (AD). This study investigated the association between consumption of different alcoholic beverages — beer, wine, and spirits — and one of the neuropathological signs of Alzheimer’s disease, β-amyloid (Aβ) aggregation in the brain.

Researchers examined data from 125 males participating in the Helsinki sudden death autopsy series, who at the time of death were 35 to 70 years old. Consumption of alcohol, Aβ aggregation in the brain, and apolipoprotein E (APOE) genotype were assessed. Surviving relatives answered a questionnaire used to gather the drinking history of the deceased, and Aβ was observed by immunohistochemical staining of brain sections.

Read the full commentary here

Read the original research abstract here